Healthcare Provider Details

I. General information

NPI: 1962403279
Provider Name (Legal Business Name): DAVID B MCLEAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVENUE
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

4203 PICKETT ROAD
FAIRFAX VA
22032
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-0196
  • Fax:
Mailing address:
  • Phone: 703-426-5855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101055056
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: